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Type I Diabetes III: Clinical Manifestations

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Insulinoma presenting as idiopathic hypersomnia.

Michelangelo Maestri1, Fabio Monzani, Enrica Bonanni

  • 1Department of Neurosciences, Neurological Clinic, University of Pisa, via Roma 67, 56126, Pisa, Italy. m.maestri@ao-pisa.toscana.it

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|February 2, 2010
PubMed
Summary

Idiopathic hypersomnia was suspected in a patient with excessive sleepiness. However, episodes of unresponsiveness and limb jerking revealed neuroglycopenia caused by insulinoma, a rare cause of paroxysmal disorders.

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Area of Science:

  • Neurology
  • Endocrinology
  • Sleep Medicine

Background:

  • Idiopathic hypersomnia is a sleep disorder characterized by excessive daytime sleepiness.
  • A 32-year-old woman presented with symptoms suggestive of idiopathic hypersomnia, including increased sleep need and difficulty waking.

Observation:

  • During polysomnography, the patient experienced episodes of unconsciousness and limb jerking.
  • Electroencephalography (EEG) revealed diffuse theta-delta activity, and blood glucose levels dropped to 32 mg/dL.
  • These findings suggested neuroglycopenia, prompting a shift in diagnosis.

Findings:

  • A CT scan identified a hypodense mass in the pancreatic tail, consistent with insulinoma.
  • Surgical removal of the pancreatic mass (partial pancreasectomy) led to the complete resolution of symptoms.
  • Long-term follow-up confirmed the absence of neurological or physiological abnormalities.

Implications:

  • This case highlights insulinoma as a rare but critical differential diagnosis for hypersomnia and paroxysmal disorders.
  • Neuroglycopenia, particularly when presenting with atypical hypersomnia, warrants thorough investigation.
  • Clinicians should consider metabolic causes like insulinoma in patients with unexplained hypersomnia and neurological symptoms.